| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
27,622 |
27,284 |
$821K |
| D1120 |
Prophylaxis - child |
18,106 |
17,871 |
$790K |
| D1110 |
Prophylaxis - adult |
11,798 |
11,635 |
$717K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,116 |
29,722 |
$689K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,977 |
3,041 |
$618K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,173 |
3,661 |
$604K |
| D1351 |
Sealant - per tooth |
15,244 |
3,816 |
$510K |
| D0274 |
Bitewings - four radiographic images |
11,508 |
11,349 |
$261K |
| D0330 |
Panoramic radiographic image |
5,333 |
5,242 |
$228K |
| D0272 |
Bitewings - two radiographic images |
13,851 |
13,678 |
$211K |
| D0140 |
Limited oral evaluation - problem focused |
4,392 |
4,124 |
$196K |
| D7240 |
Removal of impacted tooth - completely bony |
651 |
193 |
$181K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,582 |
966 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,264 |
2,209 |
$119K |
| D1330 |
|
15,670 |
15,443 |
$96K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
190 |
187 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
218 |
160 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,406 |
3,245 |
$35K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
183 |
61 |
$29K |
| D9222 |
|
190 |
187 |
$14K |
| D9310 |
|
224 |
222 |
$11K |
| D3120 |
|
277 |
224 |
$10K |
| D2750 |
|
18 |
12 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
79 |
42 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
754 |
753 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
205 |
197 |
$4K |